Estimated Energy Requirements Research Articles

Impact of Powertrain Components Size and Degradation Level on the Energy Management of a Hybrid Industrial Self-Guided Vehicle

This paper deals with the design of an energy management strategy (EMS) for an industrial hybrid self-guided vehicle (SGV), considering the size of a fuel cell (FC) stack and degradation of a battery pack. In this context, first, a realistic energy model of the SGV was proposed and validated, based on experiments. This model provided a basis for individual components analysis, estimating energy requirements, component sizing, and testing various EMSs, prior to practical implementation. Second, the performance of the developed FC/battery SGV powertrain was validated under three EMS modes. Each mode was studied by considering four different FC sizes and three battery degradation levels. The final results showed that a small FC as a range extender is recommended, to reduce system cost. It is also important to maintain the FC in its high efficiency zones with a minimum ON/OFF cycle, leading to efficiency and lifetime enhancement of FC system. Battery SOC have to be kept at a high level during SGV operation, to support the FC during SGV acceleration. In order to improve the SGV’s overall autonomy, it is also important to minimize the stop and go and rotational SGV motion with appropriate acceleration and deceleration rate.

Throwing darts in ICU: how close are we in estimating energy requirements?

BackgroundIndirect calorimetry (IC) is the gold standard for determining energy requirement. Due to lack of availability in many institutions, predictive equations are used to estimate energy requirements. The purpose of...

The use of extensively hydrolysed and amino acid feeds beyond cow's milk allergy: a national survey.

Extensively hydrolysed formulas (EHFs) and amino acid formulas (AAFs) with proven hypoallergenicity are used for children suffering from cow's milk allergy, when breast milk is not available. However, these feeds are often used in other medical conditions where tolerance and absorption of whole protein is affected, frequently without assessment of efficacy. This practice survey assessed the use of these feeds in paediatric conditions other than cow's milk allergy; aiming to describe the population, growth parameters and micronutrient status. Four National Health Service tertiary paediatric centres participated in this practice survey. Inclusion: children between 0 and 18years, consuming >25% of their estimated energy requirements of an EHF/AAF for any condition other than allergic disease. Anonymised data were collected: (i) descriptive information; (ii) indications; (iii) type and route of feeding; (iv) growth status and nutritional deficiencies; and (v) medication and vitamin and mineral supplementation. One hundred-and-ninety-one children were included with a median age of 19months (interquartile range4-63]. Seventeen percent (33/191) were on AAFs and 83% (158/191) were on EHFs. The feeds were commonly used in cancer for 26% and in critical illness for 31%. The majority (73%) of children had enteral feeds via a nasogastric tube. Nutritional biomarkers were performed in 29% of children and 83% were on a vitamin or mineral supplement. This practice survey found that EHFs and AAFs were used in a variety of medical conditions. Indications for feed choice varied, and evidence-based research supporting the use was scarce. Awaiting further research, children on these types of feeds should have regular nutritional monitoring.

Estimating total daily energy requirements in community-dwelling older adults: validity of previous predictive equations and modeling of a new approach.

Accurate estimation of energy requirements is crucial for health maintenance and prevention of malnutrition in older adults. This study aimed to assess the accuracy of predictive equations for estimating energy requirements in older adults and to test the validity of new predictive equations for this age group. This is a cross-sectional study including 38 Brazilian community-dwelling older adults aged 60-84 years, who had their total energy expenditure measured by doubly labeled water (TEEDLW). The energy expenditure was compared to the Institute of Medicine (Dietary Reference Intake (DRI)) and Vinken et al. previous predictive equations and three predictive models developed in a modeling sample. The agreement was assessed using intra-class correlation coefficient, Bland-Altman plots, and Lin's concordance correlation. Accuracy was evaluated considering ±10% of the ratio between estimated and measured energy expenditure. The mean (standard deviation) TEEDLW was 2656.7 (405.6) kcal/day for men and 2168.9 (376.9) for women. Vinken et al. and both DRI equations presented moderate to good degree of agreement, while the developed models vary from fair to very good agreement in comparison to DLW. The accuracy rate was the same for both DRI equations and Vinken et al. equation (60.53%). The new equations developed in this study had accuracy in predicting TEE for Brazilian older adults varying from 43.11% to 73.68%. The results corroborate the use of previous predictive equations for estimating energy requirements in Brazilian older adults. Further studies have the potential to explore the use of the developed models to assess energy needs in this population.

Dietary education provision within a cardiac rehabilitation programme in the UK: a pilot study

Background/aims The primary aim of this study was to evaluate the effectiveness of two 30-minute dietary education sessions, within cardiac rehabilitation, as a means to optimise nutrient and energy intakes. A secondary aim was to evaluate patients' habitual physical activity levels. Methods Thirty patients (males: n=24, 61.8±11.2 years; females: n=6, 66.7±8.5 years) attended a 6-week early outpatient cardiac rehabilitation programme in the UK and received two 30-minute dietary education sessions emphasising Mediterranean diet principles. Energy intakes and nutrient intakes were measured through completion of 3-day food diaries in weeks one and six (before and after the dietary education sessions) to assess the impact of these sessions on nutrient intakes. At the same time-points, a sub-group (n=13) of patients had their physical activity levels assessed via accelerometery to assess the impact of the cardiac rehabilitation programme on physical activity. Results Estimated energy requirements at week one (1988±366 kcal d−1) were not matched by actual energy intakes (1785±561 kcal d−1) (P=0.047, d=−0.36). Energy intakes reduced to 1655±470 kcal d−1 at week six (P=0.66, d=−0.33) whereas estimated energy requirements increased as a function of increased activity (cardiac rehabilitation sessions). Nutrient intakes remained suboptimal, while no significant increases were observed in healthy fats and fibre, which are core elements of a Mediterranean diet. Statistically significant increases were not observed in physical activity; however, patients decreased sedentary time by 11±12% in week six compared with week one (P=0.009; d=−0.54). Conclusions The present study findings suggest that two 30-minute dietary education sessions did not positively influence energy intakes and nutrient intakes, while habitual physical activity levels were not significantly increased as a result of the cardiac rehabilitation programme. Future research should explore means of optimising nutrition and habitual physical activity within UK cardiac rehabilitation.

Energy Requirement Is Higher During Weight-Loss Maintenance in Adults Consuming a Low- Compared with High-Carbohydrate Diet

ABSTRACTBackgroundLonger-term feeding studies suggest that a low-carbohydrate diet increases energy expenditure, consistent with the carbohydrate-insulin model of obesity. However, the validity of methodology utilized in these studies, involving doubly labeled water (DLW), has been questioned.ObjectiveThe aim of this study was to determine whether dietary energy requirement for weight-loss maintenance is higher on a low- compared with high-carbohydrate diet.MethodsThe study reports secondary outcomes from a feeding study in which the primary outcome was total energy expenditure (TEE). After attaining a mean Run-in weight loss of 10.5%, 164 adults (BMI ≥25 kg/m2; 70.1% women) were randomly assigned to Low-Carbohydrate (percentage of total energy from carbohydrate, fat, protein: 20/60/20), Moderate-Carbohydrate (40/40/20), or High-Carbohydrate (60/20/20) Test diets for 20 wk. Calorie content was adjusted to maintain individual body weight within ± 2 kg of the postweight-loss value. In analyses by intention-to-treat (ITT, completers, n = 148) and per protocol (PP, completers also achieving weight-loss maintenance, n = 110), we compared the estimated energy requirement (EER) from 10 to 20 wk of the Test diets using ANCOVA.ResultsMean EER was higher in the Low- versus High-Carbohydrate group in models of varying covariate structure involving ITT [ranging from 181 (95% CI: 8–353) to 246 (64–427) kcal/d; P ≤0.04] and PP [ranging from 245 (43–446) to 323 (122–525) kcal/d; P ≤0.02]. This difference remained significant in sensitivity analyses accounting for change in adiposity and possible nonadherence.ConclusionsEnergy requirement was higher on a low- versus high-carbohydrate diet during weight-loss maintenance in adults, commensurate with TEE. These data are consistent with the carbohydrate-insulin model and lend qualified support for the validity of the DLW method with diets varying in macronutrient composition. This trial was registered at clinicaltrials.gov as NCT02068885.

Energy intake and energy contributions of macronutrients and major food sources among Chinese adults: CHNS 2015 and CNTCS 2015.

Excessive energy intake and unbalanced food choices are major health concerns associated with obesity and related chronic diseases. This study evaluates the levels of dietary energy intake and the energy contributions of macronutrients, major food sources, and various eating occasions and processed food among Chinese adults. The study examined a cross-sectional sample from CHNS and CNTCS 2015 that used three 24 h recalls and calculated energy intake and food sources based on the China Food Composition Table. After excluding extreme values, the analyses included 11,974 subjects aged 18-64. The estimated energy intake was 2063.3 kcal/d (2243.8 kcal/d for males and 1902.4 kcal/d for females), and 39.1% of subjects met the gender-age-PA-based Estimated Energy Requirement. The proportion of energy from fats was 35.8% without significant age or gender differences. Adults of lower socioeconomic statuses, indicated by lower education levels and lower household incomes per capita, consumed lower percentages of energy from fats and higher percentages from carbohydrates. The study population as a whole reported an average energy density of 1.88 kcal/g and an energy contribution from restaurant foods of 1.8%. The study reports a lower energy intake level than CHNS 2009. Adults living in southern China or urban areas, which are relatively developed regions, or with higher socioeconomic statuses consumed less energy from carbohydrates, moderate amounts from proteins, and more from fats, indicating a need for dietary guidelines or interventions that take into account socio-demographic factors.

Energy requirements for pregnant dairy cows.

This study aimed to estimate energy requirements of pregnant Holstein × Gyr cows. Different planes of nutrition were established by two feeding regimens: ad libitum or maintenance. Sixty-two nonlactating cows with average body weight of 480 ± 10.1 kg and an age of 5 ± 0.5 years were used. Cows were divided into three groups: pregnant (n = 44), non-pregnant (n = 12), and baseline reference (n = 6). The 56 pregnant and non-pregnant cows were randomly allocated into a feeding regimen: ad libitum or maintenance. To evaluate the effects of days of pregnancy, pregnant and non-pregnant animals were slaughtered at 140, 200, 240, and 270 days of pregnancy. Energy requirements for maintenance differed between pregnant and non-pregnant cows, thus two equations were developed. Net energy and metabolizable energy requirements for maintenance of non-pregnant cows were 82 kcal/kg empty body weight0.75/day and 132 kcal/kg empty body weight0.75/day, respectively. The efficiency of use of metabolizable energy for maintenance of non-pregnant cows was 62.4%. Net energy and metabolizable energy for maintenance of pregnant cows were 86 kcal/kg empty body weight0.75/day and 137 kcal/kg empty body weight0.75/day, respectively. Efficiency of use of metabolizable energy for maintenance of pregnant cows was 62.5%. The efficiency of use of metabolizable energy for gain was 41.9%. The efficiency of use of metabolizable energy for pregnancy was 14.1%. Furthermore, net energy requirement for pregnancy was different from zero from day 70 of pregnancy onwards. In conclusion, net energy and metabolizable energy requirements for maintenance of non-pregnant cows are different from pregnant cows. Furthermore, we believe that the proposed non-linear equations to estimate net energy requirements for pregnancy are more adequate than current NRC equation, and should be recommended for Holstein × Gyr cows.

The Effect Of Continuous Energy Restriction Vs Intermittent Fasting, With Resistance Training, On Lean Mass

PURPOSE: To determine if two energy restricted diets (continuous energy restriction (CER) and 5:2 intermittent fasting (IF)) combined with resistance training (RT) results in lean body mass (LBM) retention while reducing bodyweight. METHODS: Thirty-four young, untrained males and females were randomised to undertake the following diets for 12 weeks: CER (consume 80% of estimated energy requirements (EER) every day), or IF (consume approximately 30% of EER twice per week on fast days and 100% of EER every other day). Fast days included meals of protein shakes, a soup and vegetables. Both groups aimed to be isocaloric with an average energy restriction of 20% EER, and isonitrogenous consuming an average protein intake of 1.5 grams per kilogram of bodyweight per day. Both groups completed 2 supervised RT sessions and 1 unsupervised workout per week. The IF group completed their exercise on non-fast days. Body composition was assessed by dual x-ray absorptiometry. Data was analysed using an intention-to-treat linear mixed model, assuming AR(1) dependence across time. In addition, a change analysis was conducted for participants who completed both the baseline and 12 week assessments. RESULTS: For females, bodyweight was significantly reduced (mean decrease 3.1%, p=0.009), and LBM significantly increased (mean increase 5.8%, p<0.001), with no difference observed between diets. Similarly for men, there was no significant diet effect on bodyweight; both groups experienced an overall reduction of 6.3% (p<0.001). Combined, men in both diet groups experienced a significant increase in LBM (mean increase 1.4%, p=0.021), however there was a trend towards a greater increase in LBM in the IF compared to the CER group (mean increase CER = 0.7%, IF = 2.0%). CONCLUSIONS: Across both diet groups, males and females experienced a significant reduction in bodyweight while, on average, increasing LBM. Neither diet was more effective for bodyweight reduction, however there was a trend towards greater LBM accrual in IF compared to CER males. Gender specific responses to the intervention were evident, with a greater increase in LBM for females. Moderate energy restriction with high protein intake and RT can lead to concomitant weight loss and LBM accrual.

Resting Energy Expenditure In Crossfit® Practitioners: Indirect Calorimetry Versus Predictive Equations

BACKGROUND: Indirect calorimetry (IC) is the gold standard method to assess individual resting energy expenditure (REE). However, due to its high cost and time demand, predictive equations are largely used to estimate energy requirements, which may vary according to different body compositions and health status. Crossfit® is a training program created by Greg Glessman in 1995 and consists of performing high intensity functional movements. Some studies have already reported increase of metabolic rates in this population. PURPOSE: To measure REE in Crossfit® practitioners, using IC, and verify the most appropriate predictive equation to estimate this variable. METHODS: 142 Crossfit® practitioners, 91 female (64.1%), aged between 16-59 years, underwent nutritional assessment, including weight, height, waist circumference (WC) and body mass index (BMI). Body composition was measured by a portable ultrasound. REE was measured by IC (mREE) and predicted by six different equations (pREE): Harris-Benedict, World Health Organization (WHO), Henry and Rees, Cunningham (1980), Cunningham (1991), and Mifflin-St.Jeor. Statistical analysis were carried out by Kolmogorov-Smirnov Test, Student’s t test and Bland and Altman plots. RESULTS: The mean age was 33.0 ± 6.3 years of age, without difference between men and women. The mean BMI was 24.7 ± 3.5 kg/m2. The mean mREE was 1583.2 ± 404.4 kcal, and the pREE ranged from 1455.5 ± 230.9 kcal to 1711.3 ± 285.5. The best REE predictive equations for Crossfit® practitioners were the Cunningham (1991) (P=0.338), WHO equation (P=0.494) and Harris-Benedict (P=0.705). Harris-Benedict presented the smaller difference comparing with IC (12.9 ± 307.6 kcal), Cunningham (1991) showed better adequacy (102.5%) and WHO equation presented greater percentage of accuracy (59.9%). The same equations remained adequate when data were stratified by gender. CONCLUSIONS: This study showed that Cunningham (1991), WHO (1985) and Harris-Benedict (1919) equations were the most appropriated REE equations for Crossfit® practitioners. Further studies should investigate more suitable methods to determine the energy requirements in Crossfit® and should, perhaps, create and propose a specific equation for this population.

Association Of Caloric Intake With Physical Fitness And Low Back Pain In Firefighters

Firefighters are at high risk of developing numerous health conditions, such as obesity, cardiovascular disorders, and low back pain (LBP), which negatively impact physical fitness, job performance, and quality of life. The influence of caloric intake on physical fitness and injury prevention has not been fully assessed in firefighters. PURPOSE: To assess the association of caloric intake with physical fitness and LBP in firefighters. METHODS: A cross-sectional study was conducted in career firefighters (n = 134 males) from 12 departments in southern California who presented for baseline assessments for a regional wellness initiative. A 3-day food record was collected to determine caloric intake using the percent of the Harris-Benedict estimated energy requirement. LBP history, LBP current status, and job function (Firefighter Functional Task Questionnaire, FFTQ) were assessed with questionnaires. Back and core muscular endurance was assessed with the Ito and Plank tests. Movement quality was assessed with the Functional Movement Screen. Relationships between caloric intake and the dependent variables were explored using Pearson’s correlation and analysis of variance. RESULTS: Significant (p </= 0.05) correlations were noted between caloric intake and core endurance (r = 0.20), FMS (r = 0.22), and FFTQ (r = 0.17). Firefighters without a history of low back pain consumed more calories than those with a history of low back pain (87.1% +/- 25.7% vs 74.8% +/- 21.9%, respectively, p = 0.02). No significant relationships were observed between caloric intake with back endurance or current LBP. CONCLUSION: This preliminary suggests that adequate caloric intake is associated with physical fitness, job performance, and LBP in firefighters. Prospective trials are needed to confirm these relationships and assess the effectiveness of nutrition interventions in firefighters.

Snacking on Whole Almonds for Six Weeks Increases Heart Rate Variability during Mental Stress in Healthy Adults: A Randomized Controlled Trial.

Cardiac autonomic regulation can be indirectly measured by heart rate variability (HRV). Low HRV, which can be induced by mental stress, is a predictor of risk of sudden cardiac death. Few studies have investigated cause-and-effect relationships between diet and HRV. Nut consumption is associated with CVD risk reduction, but the impact on HRV, particularly in response to stress, is unclear. Men and women (30–70 y) with above average risk of developing CVD were randomly assigned in a 6-week randomized, controlled, parallel arm trial to consume either whole almond or isocaloric control snacks (20% of daily estimated energy requirement). Control snacks contained the average nutrient profile of UK snacks. Five-minute periods of supine heart rate (HR) and HRV were measured at resting and during mental stress (Stroop color-word test) at baseline and six weeks. High frequency (HF) power, which reflects parasympathetic regulation of HR, was increased following almonds during the mental stress task relative to control (mean difference between groups 124 ms2; 95% CI 11, 237; p = 0.031, n = 105), but other indices were unaffected. Snacking on whole almonds instead of typical snacks may reduce risk of CVD partly by ameliorating the suppression of HRV during periods of mental stress.

Snacking on whole almonds for 6 weeks improves endothelial function and lowers LDL cholesterol but does not affect liver fat and other cardiometabolic risk factors in healthy adults: the ATTIS study, a randomized controlled trial

BackgroundThere is convincing evidence that daily whole almond consumption lowers blood LDL cholesterol concentrations, but effects on other cardiometabolic risk factors such as endothelial function and liver fat are still to be determined.ObjectivesWe aimed to investigate whether isoenergetic substitution of whole almonds for control snacks with the macronutrient profile of average snack intakes, had any impact on markers of cardiometabolic health in adults aged 30–70 y at above-average risk of cardiovascular disease (CVD).MethodsThe study was a 6-wk randomized controlled, parallel-arm trial. Following a 2-wk run-in period consuming control snacks (mini-muffins), participants consumed either whole roasted almonds (n = 51) or control snacks (n = 56), providing 20% of daily estimated energy requirements. Endothelial function (flow-mediated dilation), liver fat (MRI/magnetic resonance spectroscopy), and secondary outcomes as markers of cardiometabolic disease risk were assessed at baseline and end point.ResultsAlmonds, compared with control, increased endothelium-dependent vasodilation (mean difference 4.1%-units of measurement; 95% CI: 2.2, 5.9), but there were no differences in liver fat between groups. Plasma LDL cholesterol concentrations decreased in the almond group relative to control (mean difference −0.25 mmol/L; 95% CI: −0.45, −0.04), but there were no group differences in triglycerides, HDL cholesterol, glucose, insulin, insulin resistance, leptin, adiponectin, resistin, liver function enzymes, fetuin-A, body composition, pancreatic fat, intramyocellular lipids, fecal SCFAs, blood pressure, or 24-h heart rate variability. However, the long-phase heart rate variability parameter, very-low-frequency power, was increased during nighttime following the almond treatment compared with control (mean difference 337 ms2; 95% CI: 12, 661), indicating greater parasympathetic regulation.ConclusionsWhole almonds consumed as snacks markedly improve endothelial function, in addition to lowering LDL cholesterol, in adults with above-average risk of CVD.This trial was registered at clinicaltrials.gov as NCT02907684.

121-OR: Immunosuppressant-Related Quality of Life and Lifestyle of Insulin Independent T1D Pancreas Transplant Recipients

Background: Pancreas Transplantation (PT) provides insulin independence and improves quality of life in patients with type 1 diabetes (T1D). However, PT recipients require lifelong immunosuppression resulting in immunosuppression related side-effects. Methods: After IRB approval, we prospectively studied 15 PT recipients at least 1 year after PT. Subjects completed DEXA for body composition, actigraph for 1 week, the modified Transplant symptom occurrence and distress scale (MTSOSD) and VioFFQ - VIOCARE Food Frequency questionnaires. Results: PT recipient were 53.1 ± 10.6 years old, 12F, BMI (Kg/m2) 30.8 ± 6, 33 ± 12.3 years of T1D and 6 ± 5 years (1-17years) time interval from PT. Lab values were HbA1c 5.4 ± 0.6 %, fructosamine 233 ± 27 µmol/L, fasting glucose 94.3 ± 17.5 mg/dl, C-peptide 2.5 ± 0.9 ng/ml and eGFR 56.3 ± 25.5 ml/min. DEXA revealed 41.1 ± 8.3 % total fat with 41.2 ± 10.2 % in Arms, 39.0 ± 9.8 % Legs and 43.7 ± 10.3 % Trunk. Actigraph revealed 1.6 ± 0.3 MET rate, 13428.7 ± 4649.0 average steps/day and 58.1 ± 12.9 % in Sedentary, 26.3 ± 7.3 % in Light and 15.6 ± 6.2 % in moderate grade physical activity respectively . Viocare revealed 81.9% calories of Estimated Energy Requirement with 44.9 ± 7.1 % CHO, 36.7 ± 5.6 % total Fat, 13.5 ± 3.2 % saturated fat and 17.9 ± 3.1 % protein calories with Omega-3 and dietary fiber intake 0.1 ± 0.11 g and 23.1 ± 9.1 g respectively. On MTSOSD, at least one side effect (SE) was reported by every subject with range varying from 1 to 53 SE out of 59 in the questionnaire. Four (33%) subjects reported at least one grade 4 symptom (high distress); 1 reported grade 4 for 24 items out of 59 in questionnaire and the other 3 grade 4 for 1.7 ± 1.2 symptoms. For grade of symptoms ranging from 0 to 3, 30 ± 14 SE were reported by the 12 subjects. Conclusions: PT recipients that are insulin independent for long periods of time have suboptimal body composition and some immunosuppression related SE but perform better than average physical activity. Disclosure R. Kaur: None. C. Reid: None. S. Rizvi: None. S. Batthula: None. S.K. McCrady-Spitzer: None. B.H. Smith: None. W.K. Kremers: Research Support; Self; AstraZeneca. P. Dean: None. A. Kukla: None. M.D. Stegall: None. Y.C. Kudva: Research Support; Self; Dexcom, Inc., Roche Diabetes Care. Other Relationship; Self; Abbott.

An Egg Feeding Intervention Increased Protein Quantity and Quality Among Young Malawian Children

Abstract Objectives Adequate protein quantity and quality are necessary for child health, growth and development, but may be lacking in complementary feeding diets with limited variety and few animal source foods. We assessed the impact of an egg feeding intervention on protein quality and quantity among rural Malawian children aged 9 to 15 months. Methods We enrolled 660 children into a 6-month trial to test the effect of eggs on child growth. Children were randomly assigned to the egg group (n = 331), who received one egg per day, or the control group (n = 329). Dietary intake data were collected at 3-month midline (9–12 months old) and 6-month endline visits (12–15 months old) by 24-hour recall interview with the primary caregiver. Repeat recalls were collected in a subsample at each timepoint. Crude protein intakes were calculated using local recipe and food composition tables. Breast milk intake was estimated as the difference between the estimated energy requirement and energy intake from complementary diet. Protein intakes were adjusted using the Digestible Indispensible Amino Acid Score (DIAAS), which weighs crude amino acid intakes against amino acid requirements. Treatment group differences in DIAAS were tested with ANCOVA. Group differences in adjusted total protein intakes from complementary diet and breastfeeding were tested using the National Cancer Institute method for estimating usual mean intakes with bootstrap standard errors. Adequacy was assessed using World Health Organization protein requirements. Results The egg intervention improved protein quality of the complementary feeding diet (DIAAS of 79 egg v 61 control at midline, 86 v 72 at endline, P &amp;lt; .0001). Inclusion of breast milk in the DIAAS increased mean scores in both groups; total protein quality remained higher in the egg group. Total quality-adjusted protein intakes were 15.4 ± 0.3 g (mean ± standard error) in the egg group v 12.7 ± 0.3 g in the control group at midline and 17.1 ± 0.3 g egg group v 14.6 ± 0.3 g control at endline (P &amp;lt; .0001). Inadequacy of protein intake was lower in the egg group than the control group at midline (2% v 15%, P &amp;lt; 0.01) and very low in both groups at endline (&amp;lt;1% egg v 2% control, P &amp;gt; 0.05). Conclusions The egg intervention increased quantity and quality of protein intakes among young Malawian children, though protein inadequacy was uncommon. Funding Sources The Bill and Melinda Gates Foundation.

Intake of Free Sugars Among Young Children in Rural Malawi

Abstract Objectives The World Health Organization (WHO) recommends intake of free sugars to not exceed 10% of energy in children. The objectives of this study are to (1) estimate the proportion of infants in rural Malawi who exceed the recommended intake of free sugars and (2) describe the sources of free sugars in infant diets. Methods Among children enrolled in a randomized controlled trial of an egg feeding intervention, a secondary analysis was conducted using endline dietary data from a single 24-hour recall among 12- to 15-month-old children (n = 590). Free sugars in home-prepared foods were estimated using the gram weight of table sugar and honey in standardized local recipes. Free sugars from commercial foods were estimated using food composition data from the Nutrition Data System for Research. Foods and beverages containing free sugars were classified into seven food categories: maize porridge, sweetened tea, sweetened dairy, candy or table sugar, juice or soda, pastries, and cookies. The total grams of free sugars and grams of free sugars by food category and by commercial or home preparation were summed for each child. Breastmilk intake was not directly assessed, so total energy intake was assumed equal to the estimated energy requirement when assessing proportion of energy intake from free sugars. Results The mean intake of free sugars was 10.7 ± 13.1 g (6% of estimated energy requirement), and 22% of children exceeded recommended energy intake from free sugars. The majority of free sugars were consumed in maize porridge (5.1 g, 48% of total free sugars) followed by sweetened tea (2.0 g, 18%), sweetened dairy (1.7 g, 16%), candy or table sugar (1.0 g, 9%), juice or soda (0.3 g, 3%), pastries (0.3 g, 3%), and cookies (0.3 g, 3%). The average intake of free sugars from commercial foods or beverages was 3.5 ± 8.5 g (33% of total free sugar intake), whereas the average intake from home-prepared foods or beverages was 7.1 ± 9.4 g (67%). Conclusions Free sugar consumption exceeded WHO recommendations in approximately one-fifth of this sample of rural Malawian children. This data suggests the greatest opportunity for reducing free sugar consumption among young children in rural villages is by targeting sugars added to home-prepared foods and beverages. Funding Sources Bill and Melinda Gates Foundation.

Almonds Improve Endothelial Function and Lower LDL Cholesterol, But Do Not Affect Liver Fat in Adults at Moderate Risk of Cardiovascular Disease: A Randomized Controlled Trial

Abstract Objectives The ATTIS study aimed to investigate whether substituting almonds for typical snacks (high in refined starch, free sugars and saturated fats, and low in fibre) influenced cardiometabolic risk factors. Primary outcomes, endothelial function and liver fat, were measured in healthy adults aged 30–70 y who were habitual snackers and at moderate risk of developing cardiovascular disease (CVD). It was hypothesized that snacking on almonds would improve endothelial function and decrease liver fat. Methods Following a 2-week run-in period consuming control snacks, a 6-week parallel arm trial was conducted where participants were randomized to isoenergetic treatments: 1) control snacks (mini-muffins) replicating an average snack nutrient profile, calculated from snack foods identified in 4-d food diaries from a national dietary intake database, or 2) dry-roasted whole almonds, providing 20% estimated energy requirement. Endothelial function (via flow-mediated dilation (FMD)); abdominal subcutaneous and visceral fat, and liver, muscle and pancreatic fat (via MRI/MRS); day- and night-time heart rate variability (HRV) and 24 h ambulatory blood pressure (ABP); blood biomarkers of insulin sensitivity and lipid profile; and fecal short chain fatty acids (SCFA) were assessed at baseline and endpoint. A total of 107 participants (75 F, 32 M; mean age 56.2 y, SD 10.4) were randomized and 105 subjects completed the trial. Results Almonds significantly increased FMD (mean difference 4.1%, 95% CI 2.2, 5.9), the long-phase HRV index, night-time very-low frequency power (mean difference 337 ms2, 95% CI 12, 661) and plasma oleic acid levels (mean difference 228 μmol, 95% CI 7, 449) relative to control adjusted for baseline BMI and baseline dependent outcome values, but there were no treatment differences in ABP and subcutaneous, visceral, liver, muscle and pancreatic fat. Plasma LDL cholesterol levels were significantly decreased by almonds (mean difference −0.25 mmol/L, 95% CI −0.45, −0.04), but no differences were found in other blood lipids, insulin sensitivity, nor fecal SCFA levels. Conclusions These novel findings suggest almonds may be cardioprotective by increasing availability of nitric oxide and improving cardiac autonomic function, in addition to their well-established LDL cholesterol-lowering properties. Funding Sources Almond Board of California.

Effects of Daily Intake of Almonds on Cardiac Autonomic Functions Measured by Heart Rate Variability in Response to Acute Stress: A Randomized Controlled Trial

Abstract Objectives Stress is inversely associated with heart rate variability (HRV), an indicator of cardiac autonomic function and a predictor of risk of sudden cardiac death. At times of stress, people tend to favor high sugar and fatty foods, often as snacks, with potential adverse effects on cardiometabolic health. Dietary recommendations for cardiovascular disease (CVD) prevention emphasize fruits, vegetables, wholegrains and nuts. There is evidence that consumption of nuts can reduce LDL cholesterol and blood pressure and help with weight management, however the impact of nuts on HRV in response to stress is unknown. The ATTIS dietary intervention study investigated the HRV response to acute stress following 6-week substitution of almonds for typical snacks high in refined starch, free sugars and saturated fats, and low in fibre. The study population comprised adults aged 30–70 y, who were habitual snack consumers, and at moderate risk of developing CVD. It was hypothesized that snacking on almonds would increase HRV during stress tasks, when HRV is expected to be reduced due to increased sympathetic activity. Methods A 6-week randomized controlled parallel trial was conducted. Participants were randomized to 1) control snacks (mini-muffins formulated to follow the average UK snack nutrient profile), or 2) dry-roasted whole almonds, both providing 20% estimated energy requirement. Supine HRV was measured (Mega Electronics Emotion Faros 180°, 2-leads wearable ECG-HRV monitor) during resting (5 min), physical stress (blood pressure monitor cuff inflation 200 mmHg, 5 min) and mental stress (Stroop colour-word test, 5 min) tasks pre- and post-intervention. A total of 105 participants (73 females and 32 males; mean age 56.2 y, SD 10.4) completed the trial. Results Almonds significantly increased the beat-to-beat HRV parameter, high-frequency power, during the mental stress test (mean difference 124 ms2; 95% CI 11, 237; P = 0.031) relative to control, indicating increased parasympathetic regulation. There were no treatment effects during resting and the physical stress task. Conclusions Snacking on whole almonds as a replacement for typical snacks increases HRV during mental stress, indicating an increased resilience in cardiac autonomic function and a novel mechanism whereby nuts may be cardioprotective. Funding Sources Almond Board of California.

Consuming an Energy-Restricted US Healthy-Style Eating Pattern Moderate or High in Protein Confers Comparable Changes in Body Composition and Cardiometabolic Health

Abstract Objectives Several systematic reviews and meta-analyses demonstrate consuming higher versus lower protein diets attenuates lean mass loss during energy restriction. No study to date has tested this phenomenon when consuming more dietary protein than prescribed as part of a US Healthy-Style Eating Pattern (USHEP). We sought to assess the effects of consuming a USHEP with either the recommended or a higher amount of protein during energy-restriction on body composition and fasting cardiometabolic disease risk factor changes. Methods Using a randomized, parallel-design, 51 men and women (mean ± SEM; age: 47 ± 1 y; BMI: 32.6 ± 0.5 kg/m2) consumed a controlled USHEP containing 750 kcal/d less than their estimated energy requirement for 12 wk. Participants were randomized to consume either 5 oz-eq/d or 12.5 oz-eq/d of protein foods. The additional dietary protein (7.5 oz-eq/d) from animal-based protein sources displaced predominantly whole and refined grains. Body composition (air displacement plethysmography) and fasting cardiometabolic health risk factors were measured at pre-, mid- (week 6), and post-intervention (week 12). Results Dietary protein intake did not affect any of the body composition or fasting cardiometabolic disease risk factors measured. Among all participants, over time, body mass (−6.2 ± 0.4 kg), fat mass (−6.9 ± 0.6 kg), and fat mass % body mass (−5.3 ± 0.6%) decreased (all P &amp;lt; 0.001). Lean mass (0.7 ± 0.5 kg) did not change and lean mass % body mass (5.3 ± 0.6%) increased (P &amp;lt; 0.001). Fasting serum insulin (−4.2 ± 0.9 μU/mL), total cholesterol (−17 ± 3 mg/dL), high-density lipoprotein cholesterol (−5 ± 1 mg/dL), low-density lipoprotein cholesterol (−7 ± 3 mg/dL), and triglyceride (−24 ± 6 mg/dL) concentrations, and seated systolic (-5 ± 1 mm Hg) and diastolic (−5 ± 1 mm Hg) blood pressures, each decreased over time (all P &amp;lt; 0.001). Conclusions Improvements in body composition and cardiometabolic health in overweight adults can be achieved by consuming a US Healthy-Style Eating Pattern with either the recommended amount of protein or higher protein from animal-based sources during weight loss. Funding Sources The Beef Checkoff and American Egg Board-Egg Nutrition Center.

Systematic Review of Equations for Estimating Energy Requirement in the Elderly: Results and Future Perspectives

Abstract Objectives Estimating the right energy requirement for the elderly is a clinically relevant topic since malnutrition is common in such population. Predictive equations are widely used to estimate the resting energy expenditure (REE). However, only a few equations have been specifically developed for the elderly, and they often provide different outputs. The present work aimed at presenting a web application able to assist the clinicians in identifying the most appropriate equation to estimate the REE in the elderly. Methods The development of the application is based on a systematic review of studies that had tested the performance of a predictive equation to estimate REE vs. a gold standard in subjects older than 65 years of age. The systematic review was carried out using PubMed, Scopus, and Embase following the PRISMA guidelines. Furthermore, the equations retrieved were applied to a sample of 88 subjects enrolled in an Italian nursing home to evaluate the agreement among the estimated REE. The agreement was assessed using the Intraclass Correlation Coefficient (ICC) for the sample overall and for specific subsets of patients (males, females, normal-weight and overweight/obese subjects). Results The initial search identified 6353 studies. After the screening, 69 studies, corresponding to 210 single equations, were included in the analysis. The type and number of parameters used in each equation were highly variable and the most frequently used were demographics, anthropometric and laboratory data, and physical activity frequency. The application of the equations to the sample of 88 subjects enrolled in the nursing home showed that the ones that included a small number of parameters were found to have a good agreement (especially those including the body weight alone: ICC = 0.75, 95% IC 0.69–0.81) while the addition of other parameters resulted in a worsening of the agreement. The same results were obtained for the sample overall and for the specific subsets of patients considered. The results of the systematic review served as a basis for the development of the web application (http://r-ubesp.dctv.unipd.it:3838/equationer). Conclusions The proposed web application is expected to guide the clinicians in identifying the most appropriate equation to estimate REE according to the subject's characteristics. Funding Sources University of Padova.